Referrals for Speech and Language Services: Are Medical Students/Residents Prepared?

Veronica Wajda (wajd0003@d.umn.edu)

Department of Communication Sciences & Disorders

University of Minnesota – Duluth

Duluth, MN 55812

Kent Brorson, PhD - Faculty Advisor (kbrorson@d.umn.edu)

Department of Communication Sciences & Disorders

University of Minnesota – Duluth

Duluth, MN 55812

Purpose

► Parents of children view pediatricians or general practitioners (GPs) as the initial contact and coordinator of necessary referrals, (Bindman, A.B., Damberg, C., Grumbach, K., Quesenberry, C.J., Selby, J.V., Truman, A., and Uratsu, C., 1999). Therefore, it is the pediatrician’s/GP’s responsibility to assess, identify, evaluate, and refer young patients with developmental delays, disorders, or other conditions that warrant early intervention services (i.e. speech-language pathology).

► A physician that simply tells a concerned parent that the child will “outgrow” his/her speech and/or language leaves the parent feeling helpless. This is usually the least favorable option and may have serious consequences in the child’s future communication development.

Studies have examined the referral rates of pediatricians regarding various health conditions of children. Research by Baker, A.E., Bocian, A., Forrest, C.B., Glade, G.B., Kang, M., and Starfield, B., (1999) found that pediatricians referred to subspecialists (i.e. audiologists, physical therapists, optometrists, SLP’s, etc.) in 11.4% of all cases. Of those, only 12% were directed toward SLP’s. Another similar study found in the February 2000, edition of Contemporary Pediatrics, noted that pediatric referral rates appear to be on the rise. However, referrals to SLP’s were not listed in the top ten; nor were they even mentioned. One notable study found that pediatricians who had periodic contact with SLP’s had higher referral rates, suggesting the importance of successful communication between the two professions (Hamilton, L., Keating, D., McMahon, S., & Syrmins, M., 1998). Based on the above findings, it seems necessary to assess the quality of training for future pediatricians in relation to their ability to effectively refer children with various communication disorders. Thus, the research question in this study is, “Do the medical students/residents have adequate knowledge to refer a child with a communication disorder to a SLP?”

Procedures

♦ Participants: Medical students and residents in various years of schooling (1^st – 4^th years) and residency (1^st – 3^rd years), and a control group of ASHA certified speech-language pathologists.

♦ Selection Criteria: The medical students/residents were recruited from various medical Internet forums and listservs. The SLPs were obtained through the American Speech, Language, and Hearing Association’s e-mail directory.

♦ Task: All participants completed an Internet survey, created using Perseus Survey Solution for the Web, a software program for design and distribution of Internet surveys. The sample consisted of questions concerning demographic data, education and training, and case scenarios. The participants were asked to determine whether the case scenarios did/did not require a referral to a SLP.

Outcomes and Conclusions

20 medical students/residents responded and 20 speech-language pathologists responded to the survey. The following is a listing of education levels of the medical students/residents:

Number of Respondees	Year in Medical School/Residency
5	1^st year medical school
3	2^nd year medical school
1	3^rd year medical school
5	4^th year medical school
2	2^nd year residency
6	Other

Demographic Data for Medical Students/Residents:

Specialty: Familiarity w/SLP: Training: Previous Referrals

• Pediatrics: 9 • Familiar: 12 • 0 hours: 8 students To a SLP

• Family Practice: 3 • Unfamiliar: 8 • 1-5 hours: 8 students • 16 Have never referred

• Neurology: 1 • 6-10 hours: 2 students • 4 Have referred

• 1 semester: 1 student

• >1 semester: 1 student

The following table illustrates the percentages of the correct answers to the case scenarios:

Referrals Necessary	% Referral by Meds	% Referral By SLPs
Autism	38%	86%
Global Devel. Delay	48%	100%
Developmental Apraxia of Speech	71%	100%
Stuttering	86%	100%
Voice Disorder	24%	95%
Cleft Palate	95%	86%
Language Delay	38%	52%

No Referral Necessary	% Referral by Meds	% Referral by SLPs
Stuttering	19%	0%
Normal Phonological Errors	43%	29%
Borderline Language Development	14%	0%

Totals: Med %correct SLP % correct

Referral Necessary	57%	88%
Non-Referrals	64%	70%
Overall	59%	83%

Discussion

►Medical Students/Residents may not be trained sufficiently in the area of speech/language development & disorders. Their overall score is near 60% in their ability to properly refer/not refer a child, while the SLP’s overall score is above 80%, indicating a difference between the two groups.

►16 of 21 participants responded that they had 5 hours or less training in speech-language pathology.

►Medical programs should re-examine their curriculum to evaluate the topics covered. It appears that more attention should be focused on communication development and disorders. Programs may be lacking in this regard, and the need to inform the educational institutions that train future doctors would be beneficial.

References:

Baker,A.E., Bocian, A.B., Forrest, C.B., Glade, G.B., Kang, M., Starfield, B. (1999). The pediatric primary-specialty care interface. Arch Pediatric Adolescent Medicine, 153, 705-714.

Bindman, A.B., Damberg, C., Grumbach, K., Quesenberry, C. Jr., Selby, J.V., Truman, A., Uratsu, C. (1999). Resolving the gatekeeper conundrum: what patients value in primary care and referral to specialists. Journal of the American Medical Association, 282, 261-266.

Hamilton,L., Keating, D., McMahon, S., Syrmis, M. (1998). Pediatricians: referral rates and speech pathology waiting lists. Journal of Pediatrics and Child Health, 5, 451-5.

Pediatric referrals on the (surprise) upswing! (2000, February). Copy Editor, 17, 97

Perseus Survey Solutions for the Web. (1997). Braintree, MA: Perseus Development Corporation